Westra Daan, Angeli Federica, Kemp Ron, Batterink Maarten, Reitsma Jan
Health Care Manage Rev. 2022;47(1):37-48. doi: 10.1097/HMR.0000000000000302.
Despite a lack of supporting evidence, hospitals continue to merge in pursuit of quality improvements.
We seek to develop a more thorough understanding of the quality effects of hospital mergers by integrating various theoretical perspectives using a mixed-methods design.
Quantitatively, we tested the quality effect of all consummated hospital mergers in the Netherlands between 2008 and 2014 on 15 quality indicators (with 82 measurements at hospital, department, and disease levels) using a difference-in-difference approach with Bonferroni correction. Qualitatively, we conducted three comparative case studies to examine how hospital executives, managers, and medical professionals perceive the quality impact of hospital mergers.
Our quantitative results reveal few significant effects of hospital mergers on quality of care at all levels. After applying Bonferroni correction, two quality indicators are negatively associated with hospital mergers. However, the qualitative results indicate that hospital staff have positive perceptions of the mergers' quality implications, resulting from scale and shock effects.
The perceptions of hospital staff regarding mergers diametrically oppose their measurable effects. However, the operationalization of quality by hospital staff members differs considerably from the way it is quantitatively measured. The positive perceptions of hospital staff toward mergers could further contribute to the institutionalization of mergers as a quality improvement strategy.
Hospital managers seeking measurable quality improvements should be wary of merging, despite potential positive perceptions toward it within the organization. In case they do decide to merge, mitigating difficulties in the postmerger integration processes seem most pertinent to achieve measurable effects.
尽管缺乏支持证据，但医院仍在继续合并以追求质量提升。
我们试图通过运用混合方法设计整合各种理论观点，更全面地理解医院合并对质量的影响。
在定量方面，我们采用带有邦费罗尼校正的双重差分法，测试了2008年至2014年荷兰所有已完成的医院合并对15项质量指标（在医院、科室和疾病层面进行了82次测量）的质量影响。在定性方面，我们进行了三项比较案例研究，以考察医院高管、管理人员和医疗专业人员如何看待医院合并对质量的影响。
我们的定量结果显示，医院合并在各个层面上对医疗质量几乎没有显著影响。应用邦费罗尼校正后，有两项质量指标与医院合并呈负相关。然而，定性结果表明，医院工作人员对合并的质量影响持积极看法，这是由规模效应和冲击效应导致的。
医院工作人员对合并的看法与合并的可衡量效果截然相反。然而，医院工作人员对质量的操作化定义与定量测量方式有很大差异。医院工作人员对合并的积极看法可能会进一步促使合并作为一种质量改进策略制度化。
寻求可衡量质量提升的医院管理者应警惕合并，尽管组织内部可能对合并有积极看法。如果他们确实决定合并，减轻合并后整合过程中的困难似乎对于实现可衡量的效果最为关键。
